State Injury Indicators Report

Transcription

1 State Injury Indicators Report Third Edition 2004 Data U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Injury Prevention and Control July 2007 The State Injury Indicators Report, Third Edition 2004 Data is a publication of the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

2 Editors Renee L. Johnson, RPT, MSPH Division of Injury Response National Center for Injury Prevention and Control Robert G. Thomas, Jr., MSIM Office of Statistics and Programming National Center for Injury Prevention and Control Karen E. Thomas, MPH Division of Injury Response National Center for Injury Prevention and Control Nimeshkumar Patel, MS Office of Statistics and Programming National Center for Injury Prevention and Control Kelly Sarmiento, MPH Division of Injury Response National Center for Injury Prevention and Control Acknowledgements The editors thank the State and Territorial Injury Prevention Directors Association, the Council of State and Territorial Epidemiologists, and their respective members. These partners have facilitated the ongoing advancement and success of the development of the injury indicators. The editors also thank Kevin Webb from the Office of Statistics and Programming and Angela Marr from the Division of Injury Response, National Center for Injury Prevention and Control, for their consultation and guidance. Centers for Disease Control and Prevention Julie L. Gerberding, MD, MPH Director National Center for Injury Prevention and Control Ileana Arias, PhD Director Suggested Citation: Johnson RL, Thomas RG, Thomas KE, Patel N, Sarmiento K. State Injury Indicators Report, Third Edition 2004 Data. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; ii

3 Contributors Arizona Department of Health Services Jennifer Jung, MSPH Tomi St. Mars, RN, BSN, CEN Arkansas Department of Health and Human Services J. Edward Carson, MHA Paul W C Johnson, MSPH Elaine Anthony Jones Gayla Nooner, MA Thomas S. Rainer, BBA California Department of Health Services Jennifer Harper, MSPH Colorado Department of Public Health and Environment Kirk A. Bol, MSPH Holly B. Hedegaard, MD, MSPH Connecticut Department of Public Health Susan J. Hewes, MPH Jennifer Morin, MPH Justin Peng, MPH Florida Department of Health Michael Lo, MSPH Georgia Department of Human Resources Laura Fehrs, MD Bill Van Fleit, MA Manxia Wu, MD, MPH Denise Yeager Hawaii State Department of Health Daniel Galanis, PhD Kansas Department of Health and Environment Greg Crawford Lori Haskett, BA Donald Owen, MA Ghazala Perveen, MBBS, PhD, MPH Ismaila Ramon, MPH iii Kentucky Cabinet for Health and Family Services Mike D. Singleton, MS Lei Yu, MS Louisiana Department of Health and Hospitals Mona Doshani, MD, MPH Shirley Kirkconnell, MSW, MPH Maine Department of Health and Human Services Ann Farmer, MS Cindy Mervis, MPH Maryland Department of Health and Mental Hygiene Brenna C. Hogan, MPH Becky L. Roosevelt, MA Tracey Serpi, PhD Chris Tkach, PhD Massachusetts Department of Public Health Beth Hume, MPH Maria McKenna, MPH Loreta McKeown, MPH Michigan Department of Community Health Thomas W. Largo, MPH Minnesota Department of Health D. R. Hagel Mark Kinde, MPH Jon Roesler, MS Nebraska Health and Human Services System Xiaojuan Mi, MS Peg Prusa-Ogea, MA Ming Qu, PhD Lei Zhang, MS Nevada Department of Health and Human Services Kelly Langdon, MPH William Lee, BS Andrea R. Rivers, BA Wei Yang, PhD

4 New Hampshire Department of Health and Human Services David L. Reichel, MPH, DC New Mexico Department of Health Barbara Chatterjee, MS Glenda Hubbard, MPH Ajoy Kumar, MBBS, MPH Leona Woelk, MA New York State Department of Health Michael Bauer, MS Susan Hardman Erin Shortt, MPH North Carolina Department of Health and Human Services Pedro LunaOreo, PhD Catherine (Kay) Sanford, MSPH Jean Slosek, MS Ohio Department of Health David Engler, PhD (Ohio Hospital Association) Edward Socie, MS Oklahoma State Department of Health Tracy Wendling, MPH Oregon Department of Human Services Janice D. Alexander, PhD Mel Kohn, MD, MPH Lisa Millet, MSH South Carolina Department of Health and Environmental Control Georgette Demian, MPH Elizabeth Hall, BS Byron Kirby, BS Randy Rambo Tennessee Department of Health Tom Spillman, BA Utah Department of Health Catherine Groseclose, MS Gary Mower, MPH Albert Wang, MPH Vermont Department of Health Caroline W. Dawson, BS, MS, MPA Edith Munene, BA, MA, MA Patricia Worcester, PhD Virginia Department of Health Michelle White, MSW Washington State Department of Health Jennifer Sabel, PhD John Sabel, BS Wisconsin Department of Health and Family Services Randall L. Glysch, MS Pennsylvania Department of Health Nathan James, BA Robert Keyton Gerald Miller, BS Tom Truong, MS Rhode Island Department of Health Edward Donnelly, RN, MPH Janice Fontes Beatriz Perez, MPH iv

5 Table of Contents Foreword Abbreviations viii Introduction 1 Discussion of Indicators 2 Methods Hospital Discharge Data Quality Table A. Factors Affecting Representativeness of 2004 Hospital Discharge Data Highlights Limitations and Future Efforts All-Injury Indicators 11 1a. Hospitalizations for All Injuries (Overall), b. Hospitalizations for All Injuries by Sex, c. Hospitalizations for All Injuries by Age, Traumatic Brain Injury Indicators (TBI) 15 2a. TBI Fatalities (Overall), b. TBI Fatalities by Sex, c. TBI Fatalities by Age, d. TBI Hospitalizations (Overall), e. TBI Hospitalizations by Sex, f. TBI Hospitalizations by Age, Drowning Indicators 23 3a. Unintentional Drowning Fatalities (Overall), b. Unintentional Drowning Fatalities by Sex, c. Unintentional Drowning Fatalities by Age, d. Nonfatal Drowning Hospitalizations (Overall), e. Nonfatal Drowning Hospitalizations by Sex, f. Nonfatal Drowning Hospitalizations by Age, vii 4. Fire-Related Indicators 31 4a. Unintentional Fire-Related Fatalities (Overall), b. Unintentional Fire-Related Fatalities by Sex, c. Unintentional Fire-Related Fatalities by Age, d. Unintentional Fire-Related Hospitalizations (Overall), e. Unintentional Fire-Related Hospitalizations by Sex, f. Unintentional Fire-Related Hospitalizations by Age, Firearm Related Indicators 39 5a. Firearm-Related Fatalities (Overall), b. Firearm-Related Fatalities by Sex, c. Firearm-Related Fatalities by Age, d. Firearm-Related Hospitalizations (Overall), e. Firearm-Related Hospitalizations by Sex, f. Firearm-Related Hospitalizations by Age, g. Percentage of Adults Living in Homes with Loaded and Unlocked Firearms, Homicide Indicators 47 6a. Homicide (Overall), b. Homicide by Sex, c. Homicide by Age, Suicide Indicators 51 7a. Suicide (Overall), b. Suicide by Sex, c. Suicide by Age, d. Suicide Attempt Hospitalizations (Overall), e. Suicide Attempt Hospitalizations by Sex, f. Suicide Attempt Hospitalizations by Age, Motor Vehicle Indicators 59 8a. Unintentional Motor Vehicle Traffic Fatalities Overall), b. Unintentional Motor Vehicle Traffic Fatalities, by Sex, c. Unintentional Motor Vehicle Traffic Fatalities, by Age, d. Unintentional Motor Vehicle Traffic and Non-Traffic Hospitalizations (Overall), v

6 8e. Unintentional Motor Vehicle Traffic and Non-Traffic Hospitalizations by Sex, f. Unintentional Motor Vehicle Traffic and Non-Traffic Hospitalizations by Age, g. Of the Adults Reporting Drinking at Least One Alcoholic Beverage in the Past Month, the Percentage Reporting Driving after Perhaps Having Too Much to Drink in the Past Month, 2004, Behavioral Risk Factor Surveillance System h. Alcohol-Related Crash Deaths, Poisoning Indicators 69 9a. Poisoning Fatalities (Overall), b. Poisoning Fatalities by Sex, c. Poisoning Fatalities by Age, d. Poisoning Hospitalizations (Overall), e. Poisoning Hospitalizations by Sex, f. Poisoning Hospitalizations by Age, vi

7 Foreword The Centers for Disease Control and Prevention s (CDC) National Center for Injury Prevention and Control (NCIPC) is pleased to provide this third edition of the State Injury Indicators Report which presents 2004 data. We hope state public health officials and others will find the injury surveillance data presented in this report useful in making decisions about prevention efforts to reduce the burden of injury in the United States. The methods used to prepare these data are consistent with those used in previous cycles of injury indicator data collection. The methods are based on recommendations presented in the Consensus Recommendations for Using Hospital Discharge Data for Injury Surveillance and from the National Public Health Surveillance System (NPHSS) indicators developed by the State and Territorial Injury Prevention Directors Association (STIPDA) and the Council of State and Territorial Epidemiologists (CSTE). With partner feedback and updated consensus recommendations, CDC continuously modifies and updates the instructions and methods used to prepare these data. Thirty-four states participated in data submission either as a part of CDC Program Announcement or through voluntary submission. As more states and U.S. territories participate in this surveillance effort, a broader picture of the burden of injuries can be presented and priorities for prevention can be targeted. NCIPC looks forward to continuing to work with partners to advance and improve injury surveillance using state-based data on fatal and nonfatal injuries. vii

8 Abbreviations BAC BRFSS CDC CSTE FARS HDD ICD-10 ICD-9-CM NCIPC NHTSA NPHSS NVSS SAVIR STIPDA TBI WHO Blood alcohol concentration Behavioral Risk Factors Surveillance System Centers for Disease Control and Prevention Council of State and Territorial Epidemiologists Fatality Analysis Reporting System Hospital discharge data International Classification of Diseases Tenth Revision International Classification of Diseases Ninth Revision Clinical Modifications National Center for Injury Prevention and Control National Highway Traffic Safety Administration National Public Health Surveillance System National Vital Statistics System Society for Advancement of Violence and Injury Research State and Territorial Injury Prevention Directors Association Traumatic brain injury World Health Organization WISQARS Web-based Injury Statistics Query and Reporting System viii

9 Introduction Surveillance is one of the most important and basic elements of injury prevention and control. It helps determine the magnitude of injury morbidity and mortality, the leading causes of injury, and the population groups and behaviors associated with the greatest risk of injury. Surveillance data are also fundamental to determining program and prevention priorities. Furthermore, these data are crucial for evaluating the effectiveness of program activities and for identifying problems that need further investigation. Injury continues to be the leading cause of death and disability among children and young adults. 1 In 2004, more than 167,000 people died from injuries in the U.S. Of the deaths, 27% were from motor-vehicle crashes, 19% were from suicide, and 10% were from homicide. 1 Additionally, in 2004, more than 29.6 million people were treated for injuries in U.S. emergency departments. 1 The economic cost of injuries is also significant. The total cost of the 50 million medically treated injuries sustained in 2000 is estimated to be $406 billion in medical expenses and productivity losses. 2 The mission of public health includes prevention, mitigation, assurance of access to treatment, and reduction of injury-related disability and death. 3 The scope of public health encompasses injuries involving any mechanism (e.g., firearm, motor vehicle, or burn) and includes both intentional and unintentional injuries. An important part of the public health mission is to emphasize that injuries are preventable and to dispel the misconception that injuries are unavoidable. factors. 4 The goal is to improve state-based injury surveillance to better support injury prevention programs and policies. By enhancing and standardizing methods used to track fatal and nonfatal injuries at the state level, its integration with overall public health surveillance as part of the National Public Health Surveillance System (NPHSS) will be much easier. 5 With the State Health Department Consensus Recommendations, CSTE and STIPDA developed injury indicators that were formally adopted for inclusion in NPHSS. 6,7 The NPHSS injury indicators add to other indicators developed by CSTE for chronic diseases and other areas. 6 The Consensus Recommendations for Using Hospital Discharge Data for Injury Surveillance, published in 2003, has provided clear and specific recommendations about the evaluation and use of hospital discharge data. 8 It presents important considerations for the evaluation of data quality and outlines the methods for developing an injury hospitalization data set. The collection and dissemination of injury indicators in this report is the implementation of the foundation laid by the publication of the STIPDA and CSTE documents. It is the next step in the collaborative progress of building strong state-based injury surveillance that is comparable between jurisdictions. Recognizing the need for more comprehensive injury surveillance data, the State and Territorial Injury Prevention Directors Association (STIPDA) produced Consensus Recommendations for Injury Surveillance in State Health Departments in These recommendations were developed by a working group representing STIPDA, the Council of State and Territorial Epidemiologists (CSTE), the Centers for Disease Control and Prevention (CDC) and its National Center for Injury Prevention and Control (NCIPC), and the Society for Advancement of Violence and Injury Research (SAVIR). The State Health Department Consensus Recommendations identified 14 specific injuries and injury risk factors to be placed under surveillance by all states and 11 data sets to monitor these injuries and risk

10 Discussion of Indicators Methods The data presented in this report are drawn from a combination of state vital statistics records, state hospital discharge data (HDD), the National Vital Statistics System (NVSS), the Behavioral Risk Factor Surveillance System (BRFSS), and the Fatality Analysis Reporting System (FARS). The methods used to prepare this report were fully delineated in the companion publication, State Injury Indicators: Instructions for Preparing 2004 Data. 9 In brief, injury hospitalization cases were identified from state-based HDD using the principal diagnosis (or first-listed diagnosis code) along with other selective factors. Injury deaths were identified from vital statistic using the underlying-cause-of-death codes. For the fatal TBI indicator, all multiple-cause-of-death fields were searched. For comparison purposes, national rates for the fatality indicators were generated by using the NVSS. What is an Injury Indicator? An injury indicator describes a health outcome of an injury, such as hospitalization or death, or a factor known to be associated with an injury. The following International Classification of Diseases Tenth Revision (ICD-10) 10 and International Classification of Diseases Ninth Revision Clinical Modifications (ICD-9-CM) 11 code groupings were used to identify cases of injury-related death and hospitalizations, respectively. Hospitalizations for all injuries Diagnosis codes: , 909.4, , , Traumatic brain injury fatality Diagnosis codes: S01.0 S01.9, S02.0, S02.1, S02.3, S02.7 S02.9, S06.0 S06.9, S07.0, S07.1, S07.8, S07.9, S09.7 S09.9, T01.0, T02.0, T04.0, T06.0, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9 Traumatic brain injury hospitalizations Diagnosis codes: , , , Unintentional drowning fatality W65 W74, V90, V92 Nonfatal drowning hospitalizations Diagnosis code: E830, E832, E910, E954, E964, E984 Unintentional fire-related fatality X00 X09 Unintentional fire-related hospitalizations E890 E899 Firearm-related fatality W32 W34, X72 X74, X93 X95, Y22 Y24, Y35.0 Firearm-related hospitalizations E922.0 E922.3, E922.8, E922.9, E955.0 E955.4, E965.0 E965.4, E985.0 E985.4, E970 Homicide X85 Y09, Y87.1 Suicide X60 X84, Y87.0 Suicide attempt hospitalizations E950 E959 Unintentional motor vehicle traffic fatality V02 V04 (.1,.9), V09.2, V12 V14 (.3.9), V19 (.4.6), V20 V28 (.3.9), V29 V79 (.4.9), V80 (.3.5), V81.1, V82.1, V83 V86 (.0.3), V87 (.0.8), V89.2 Unintentional motor vehicle traffic and non-traffic hospitalizations E810 E825 Poisoning fatality X40 X49, X60 X69, X85 X90, Y10 Y19, Y35.2 Poisoning hospitalizations E850 E858, E860 E869, E950 E952 E962, E972, E980 E982

11 For the BRFSS data, weighted percentages were generated by state by using the 2004 public-use data file for the questions of interest.12 Alcohol-related crash death rates were calculated by state by using the number of alcohol-related crash deaths from FARS data as the numerator and state-provided population totals for the denominator.13 An alcohol-related crash death is defined as a death due to a motor vehicle traffic crash where either the driver or a non-occupant (e.g., pedestrian) had a blood alcohol concentration (BAC) 0.01 g/dl. Hospital Discharge Data Quality The quality and completeness of hospital discharge data is affected by factors including the completeness of external-cause-of-injury coding and the inclusion or exclusion of residents in out-of-state hospitals. Both incomplete external-cause-of-injury coding completeness and the loss of state residents treated in out-of-state hospitals decrease the number of cases that can be identified and result in reporting artificially lower rates. Readers are encouraged to consider the representativeness of data from individual state hospital discharge data systems when interpreting rates based on hospital discharge data. For the 2004 data, hospital discharge data with external cause coding ranged from 66% to 100% (Table A). Ninety-four percent of the reporting states have >80% of their hospitalization data external-cause-of-injury coded; this is an increase from 56% in the 2nd edition. A parallel increase is seen in the number of states with >90% of hospitalization data external-cause-of-injury coded; 66% have >90% coded in this edition while only 35% had >90% coded in the second edition.14 Highlights The injury indicator data presented here provides a unique state-specific look at the magnitude of nine injury topic areas. With 34 states participating, an increase from 26 states in the second edition, the national representativeness of the data continues to increase. By using statespecific datasets and an agreed upon methodology, states are able to compare findings both within indicators and among states. Within a state, comparisons can be made relative to magnitude and impact of the various causes of injury. Also, as the completeness of reporting and external-cause-of-injury data continues to improve, interstate comparisons become possible. The thirty-four states are geographically diverse and both urban and rural areas are represented. These states, when considered together, provide an overview of injury in each of the indicator areas. All-Injury Indicator The individual state rates of Hospitalizations for All Injuries ranged from to per 100,000 persons. The median rate for Hospitalizations for All Injuries across the reporting states was per 100,000 persons. The individual state rate of Hospitalizations for All Injuries ranged from to per 100,000 persons among males and from to per 100,000 persons among females. The median rate for Hospitalizations for All Injuries was per 100,000 persons among males and per 100,000 persons among females. In each of the reporting states, the highest Hospitalizations for All Injuries rate was among people 85 years and older, with a range of 2,557.7 to 6,845.1 per 100,000 persons.

12 Table A Factors Affecting Representativeness of 2004 Hospital Discharge Data External Cause Percentage* External Cause Percentage* Inclusion of Readmissions and Transfers Cross-Border Hospitalization Complete Hospital Participation Arizona Arkansas California Colorado Connecticut Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin 92.8% 100.0% 100.0% 98.8% 94.7% 85.7% 95.5% 86.4% 81.5% 78.6% 86.2% 95.6% 98.9% 86.2% 84.7% 97.0% 66.0% 99.8% 99.1% 90.2% 99.0% 88.2% 89.0% 97.7% 96.7% 93.0% 96.3% 92.0% 98.4% 82.7% 98.4% 100.0% No No No No No Unknown No No No No No No No No No No Unknown No No No No No No No No No No No * Percentage of hospital discharge data injury hospitalizations with external cause coding. Incompleteness may lead to bias. Subjective assessment by health department staff whether a substantial proportion of state residents injured in-state who require hospitalization are hospitalized in a neighboring state. No data available. 4

13 Traumatic Brain Injury (TBI) Indicators The individual state rates of TBI Fatalities ranged from 7.1 to 25.2 per 100,000 persons. The national rate for TBI Fatalities was 17.9 per 100,000 persons. The individual state rate of TBI Fatalities ranged from 10.9 to 40.9 per 100,000 persons among males and from 3.8 to 12.9 per 100,000 persons among females. The national rate for TBI Fatalities was 27.8 per 100,000 persons among males and 9.1 per 100,000 persons among females. In each of the reporting states, the highest TBI Fatality rate was among people 65 years and older, with a range of 24.2 to 61.9 per 100,000 persons. The individual state rates of TBI Hospitalizations ranged from 37.2 to per 100,000 persons. The median rate for TBI Hospitalizations across all reporting states was 74.2 per 100,000 persons. The individual state rate of TBI Hospitalizations ranged from 50.1 to per 100,000 persons among males and from 26.0 to 82.2 per 100,000 persons among females. The median rate for TBI Hospitalizations was 96.7 per 100,000 persons among males and was 49.1 per 100,000 persons among females. In each of the reporting states, the highest TBI Hospitalization rate was among people 85 years and older, with a range of to per 100,000 persons. Drowning Indicators The individual state rates of Unintentional Drowning Fatalities ranged from too few cases to report to 2.6 per 100,000 persons. The national rate for Unintentional Drowning Fatalities was 1.3 per 100,000 persons. The individual state rate of Unintentional Drowning Fatalities ranged from too few cases to report to 4.5 per 100,000 persons among males, and from too few cases to report to 1.2 per 100,000 persons among females. The national rate for Unintentional Drowning Fatalities was 2.1 per 100,000 persons among males and 0.5 per 100,000 persons among females. The individual state rates of Nonfatal Drowning Hospitalizations ranged from too few cases to report to 4.4 per 100,000 persons. The median rate for Nonfatal Drowning Hospitalizations across all reporting states was 0.7 per 100,000 persons. The individual state rate of Nonfatal Drowning Hospitalizations ranged from too few cases to report to 6.4 per 100,000 persons among males, and from too few cases to report to 1.7 per 100,000 persons among females. Median rates for male and female Nonfatal Drowning Hospitalizations were not reported due to low case counts. Fire-Related Indicators The individual state rates of Unintentional Fire-Related Fatalities ranged from too few cases to report to 2.5 per 100,000 persons. The national rate for Unintentional Fire-Related Fatalities was 1.1 per 100,000 persons. The individual state rate of Unintentional Fire-Related Fatalities ranged from too few cases to report to 3.6 per 100,000 persons among males and from too few cases to report to 1.7 per 100,000 persons among females. Among males, the national rate for Unintentional Fire-Related Fatalities was 1.4 per 100,000 persons and among females the national rate was 0.8 per 100,000 persons. The individual state rates of Unintentional Fire-Related Hospitalizations ranged from too few cases to report to 6.5 per 100,000 persons. The median rate for Unintentional Fire-Related Hospitalizations across all reporting states was 3.3 per 100,000 persons. The individual state rate of Unintentional Fire-Related Hospitalizations ranged from too few cases to report to 10.2 per 100,000 persons among males and from too few cases to report to 3.4 per 100,000 persons among females. The median rate for Unintentional Fire-Related Hospitalizations was 5.3 per 100,000 persons among males and 2.1 per 100,000 persons among females. Firearm Related Indicators The individual state rates of Firearm-Related Fatalities ranged from 3.1 to 19.6 per 100,000 persons. The national rate for Firearm-Related Fatalities was 10.0 per 100,000 persons.

14 The individual state rate of Firearm-Related Fatalities ranged from 5.5 to 35.0 per 100,000 persons among males, and from too few cases to report to 5.3 per 100,000 persons among females. The national rate for Firearm-Related Fatalities was 17.7 per 100,000 persons among males and 2.7 per 100,000 persons among females. In the reporting states, the highest Firearm-Related Fatality rate was most commonly found among persons in the year age group. However, in some states the highest rates were in persons years, 65 years and older, or years. The individual state rates of Firearm-Related Hospitalizations ranged from 1.6 to 15.8 per 100,000 persons. The median rate for Firearm-Related Hospitalizations across all reporting states was 7.5 per 100,000 persons. The individual state rate of Firearm-Related Hospitalizations ranged from too few cases to report to 29.2 per 100,000 persons among males, and from too few cases to report to 5.3 per 100,000 persons among females. The median rate for Firearm-Related Hospitalizations was 13.3 per 100,000 persons among males and 2.1 per 100,000 persons among females. In most of the reporting states, the highest Firearm-Related Hospitalization rate was among person years. Based on results from the Behavioral Risk Factor Surveillance System, 0.6% to 10.3% of adults lived in a home with a loaded and unlocked firearm for the 34 states reporting indicator data. The median percent was 3.8%. Homicide Indicator The individual state rates of Homicides ranged from too few cases to report to 13.0 per 100,000 persons. The national rate for Homicides was 5.9 per 100,000 persons. The individual state rate of Homicides ranged from too few cases to report to 21.2 per 100,000 persons among males and from too few cases to report to 5.7 per 100,000 persons among females. The national rate for Homicides was 9.2 per 100,000 persons among males and 2.6 per 100,000 persons among females. In the reporting states, the highest Homicide rate was most commonly found in the year age group. However, in several states the highest rate was among person years. Suicide Indicators The individual state rates of Suicides ranged from 6.3 to 18.9 per 100,000 persons. The national rate for Suicides was 11.0 per 100,000 persons. The individual state rate of Suicides ranged from 10.6 to 31.7 per 100,000 persons among males, and from too few cases to report to 8.0 per 100,000 persons among females. The national rate for Suicides was 18.0 per 100,000 persons among males and 4.5 per 100,000 persons among females. In the reporting states, the highest Suicide rate was most commonly found in the year age group. However, in some states the highest rates were for persons years, 65 years and older, or years. The individual state rates of Suicide Attempt Hospitalizations ranged from 29.0 to 87.6 per 100,000 persons. The median rate for Suicide Attempt Hospitalizations across all reporting states was 47.7 per 100,000 persons. The individual state rate of Suicide Attempt Hospitalizations ranged from 21.1 to 64.4 per 100,000 persons among males and from 33.5 to per 100,000 persons among females. The median rate for Suicide Attempt Hospitalizations was 36.2 per 100,000 persons among males and 56.9 per 100,000 persons among females. In the reporting states, the highest Suicide Attempt Hospitalization rate was most commonly found in the year age group. However, in approximately a third of the reporting states, the highest rate was for person years. Motor Vehicle Indicators The individual state rates of Unintentional Motor Vehicle Traffic Fatalities ranged from 6.6 to 27.4 per 100,000 persons. The national rate for Unintentional Motor Vehicle Traffic Fatalities was 14.7 per 100,000 persons.

15 The individual state rate of Unintentional Motor Vehicle Traffic Fatalities ranged from 10.7 to 36.5 per 100,000 persons among males and from 4.3 to 18.8 per 100,000 persons among females. The national rate for Unintentional Motor Vehicle Traffic Fatalities was 20.6 per 100,000 persons among males and the national rate was 9.1 per 100,000 persons among females. In the reporting states, the highest Unintentional Motor Vehicle Traffic Fatality rate was most commonly found in the years age group. However, in a few states, the highest rate was among those 65 years and older. The individual state rates of Unintentional Motor Vehicle Traffic and Non-Traffic Hospitalizations ranged from 35.0 to per 100,000 persons. The median rate for Unintentional Motor Vehicle Traffic and Non-Traffic Hospitalizations across all reporting states was 88.0 per 100,000 persons. The individual state rate of Unintentional Motor Vehicle Traffic and Non- Traffic Hospitalizations ranged from 42.8 to per 100,000 persons among males and from 27.7 to 96.5 per 100,000 persons among females. The median rate for Unintentional Motor Vehicle Traffic and Non- Traffic Hospitalizations was per 100,000 persons among males and 63.6 per 100,000 persons among females. In the reporting states, the highest Unintentional Motor Vehicle Traffic and Non-Traffic Hospitalization rate was most commonly found in the years age group. However, in a few states, the highest rate was among persons years or persons 85 years and older. Based on results from the Behavioral Risk Factor Surveillance System from the 34 states reporting indicator data, 2.2% to 6.4% of the adults who reported drinking at least one alcoholic beverage in the past month also reported driving after perhaps having too much to drink. The median percent was 3.4%. Poisoning Indicators The individual state rates of Poisoning Fatalities ranged from 3.1 to 18.6 per 100,000 persons. The national rate for Poisoning Fatalities was 10.3 per 100,000 persons. The individual state rate of Poisoning Fatalities ranged from 3.9 to 24.0 per 100,000 persons among males and from 2.2 to 14.0 per 100,000 persons among females. The national rate for Poisoning Fatalities was 13.3 per 100,000 persons among males and 7.4 per 100,000 persons among females. In the reporting states, the highest Poisoning Fatality rate was most commonly found in the year age group. However, in approximately a third of the reporting states, the highest rate was for person years. The individual state rates of Poisoning Hospitalizations ranged from 40.6 to per 100,000 persons. The median rate for Poisoning Hospitalizations across all reporting states was 74.1 per 100,000 persons. The individual state rate of Poisoning Hospitalizations ranged from 32.6 to 99.5 per 100,000 persons among males and 48.7 to per 100,000 persons among females. The median rate for Poisoning Hospitalizations was 62.4 per 100,000 persons among males and 81.1 per 100,000 persons among females. In the reporting states, the highest Poisoning Hospitalization rate was most commonly found in the year age group. However, in some states the highest rates were for persons years, years, or years. Based on data from the Fatality Analysis Reporting System, alcohol-related crash death rates ranged from 2.9 to 11.1 per 100,000. The alcohol-related crash death rate for the United States was 5.7 per 100,000.

16 Limitations and Future Efforts While this report provides important information for understanding injury, the following limitations are should be considered: Only injuries severe enough to lead to either hospitalization or death are reported. Injuries that lead to emergency department visits, physician office visits, or remain untreated need to be accounted for if the total burden of injury is to be understood. Not all causes of injury have been included in this report. The absence of fall-related indicators is noted. Representation from all states and territories has not yet been achieved. Quality and completeness of external-cause-of-injury coding, while improving, continues to be incomplete. Future editions of the State Injury Indicators Report will strive to address these limitations. NCIPC, STIPDA, and CSTE, in conjunction with participating states, will continue to refine current indicators and define new ones for inclusion in future editions of this report. In keeping with the consensus building process and the publication of Consensus Recommendations for Surveillance of Falls and Fall-Related Injuries 15 the next edition will include the recommended indicators for fall-related injuries. The incorporation of emergency department data into future editions is under exploration and consideration. Finally, submission of data from additional states and territories is encouraged and welcomed.

17 References 1. Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system (WISQARS). Atlanta (GA); [cited 2007 Mar 28]. Available from: 2. Finkelstein EA, Corso PS, Miller TR Associates. Incidence and economic burden of injuries in the United States. New York: Oxford University Press; Institute of Medicine (US). Reducing the burden of injury, advancing prevention and treatment. Washington (DC): National Academy Press; State and Territorial Injury Prevention Directors Association (STIP- DA). Consensus recommendations for injury surveillance in state health departments. Marietta (GA): STIPDA; Meriwether RA. Blueprint for a national public health surveillance system for the 21st century. J Public Health Manag Pract. 1996; Council of State and Territorial Epidemiologists. Injury control and prevention position statement. [cited 2007 Mar 29]. Available from: International Classification of Diseases 9th Revision Clinical Modification. [cited 2007 Mar 29]. Available from: otheract/icd9/abticd9.htm. 12. Centers for Disease Control and Prevention. Behavioral risk factor surveillance system: technical documents and survey data. [cited 2007 Mar 28]. Available from: National Highway Traffic Safety Administration. Traffic safety facts [cited 2007 Mar 28]. Available from://www-nrd.nhtsa.dot.gov/ pdf/nrd-30/ncsa/tsfann/2004html/tsf2004.htm. 14. Thomas C, Butler J, Davies M, Johnson R. State injury indicators report, second edition 1999 data. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Injury Surveillance Workgroup on Falls. Consensus recommendations for surveillance of falls and fall-related injuries. Atlanta (GA): State and Territorial Injury Prevention Directors Association; State and Territorial Injury Prevention Directors Association (STIP- DA). Resolutions, October [cited 2007 Mar 29]. Available from: 8. Injury Surveillance Workgroup. Consensus recommendations for using hospital discharge data for injury surveillance. Marietta (GA): State and Territorial Injury Prevention Directors Association; Johnson RL, Sarmiento K. State injury indicators: Instructions for preparing 2004 data. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; International Classification of Diseases 10th Revision. [cited 2007 Mar 29]. Available from:

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19 All-Injury Indicators 1a. Hospitalizations for All Injuries (Overall), b. Hospitalizations for All Injuries by Sex, c. Hospitalizations for All Injuries by Age,

20 Figure 1a Hospitalizations for All Injuries (Overall), 2004 Arizona Arkansas California Colorado Connecticut Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin Age-Adjusted Rate per 100,000 Rate Number Percentage* External Cause 37, % 18, % 185, % 24, % 17, % 114, % 41, % 6, % 17, % 24, % 8, % 30, % 37, % 59, % 30, % 7, % 11, % 6, % 110, % 46, % 38, % 23, % 19, % 92, % 4, % 20, % 39, % 16, % 3, % 35, % 41, % 31, % * Percentage of hospital discharge data injury hospitalizations with external cause coding. Incompleteness may lead to bias. No data available. Rate per 100,000 population. Rates are suppressed if fewer than 20 cases were reported. Case counts are suppressed if fewer than 5 cases were reported. 12

21 Figure 1b Hospitalizations for All Injuries by Sex, 2004 MALES Age-Adjusted Rate per 100, Number 19,809 8,101 99,033 12,608 8,710 55,587 20,945 3,682 7,936 11,261 3,763 16,365 17,411 29,400 14,440 3,146 6,037 2,882 57,284 22,154 18,112 11,138 9,410 44,232 1,765 10,032 18,641 8,595 1,462 16,670 20,640 14,854 Arizona Arkansas California Colorado Connecticut Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin FEMALES Number Age-Adjusted Rate per 100,000 17,762 10,179 86,088 12,038 9,014 58,875 20,804 2,994 9,727 13,355 4,521 14,048 20,424 29,599 15,716 4,066 5,215 3,238 53,511 24,438 20,136 12,474 10,005 47,867 2,245 10,222 20,787 8,354 1,611 18,824 21,038 16, No data available. Rate per 100,000 population. Rates are suppressed if fewer than 20 cases were reported. Case counts are suppressed if fewer than 5 cases were reported. 13

22 State Figure 1c Hospitalizations for All Injuries by Age #, N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate N Rate Arizona 1, , , , , , , , ,181 1, ,143 5,348.0 Arkansas , , , , , , ,131 2, ,708 5,660.3 California 6, , , , , , , , ,594 1, ,619 4,205.9 Colorado , , , , , , , ,591 2, ,073 5,582.8 Connecticut , , , , , , ,990 1, ,894 3,526.0 Florida 2, , , , , , , , ,184 1, ,691 4,660.8 Georgia 1, , , , , , , , ,962 2, ,520 4,744.3 Hawaii , ,602.4 Kansas , , , , , , ,346 2, ,198 5,808.7 Kentucky , , , , , , ,210 2, ,005 5,091.1 Louisiana Maine , ,421 2, ,331 5,304.7 Maryland , , , , , , , ,374 1, ,338 4,033.7 Massachusetts , , , , , , , ,063 2, ,619 4,862.4 Michigan 1, , , , , , , , ,054 1, ,453 4,257.2 Minnesota , , , , , , , ,822 2, ,576 4,659.2 Nebraska ,539 1, ,505 4,191.0 Nevada , , , , , , ,566 1, ,397.1 New Hampshire ,069 1, ,478.7 New Mexico New York 4, , , , , , , , ,047 1, ,107 4,268.9 North Carolina , , , , , , , ,996 2, ,706 4,682.6 Ohio , , , , , , , ,371 1, ,331 2,557.7 Oklahoma , , , , , , , ,730 2, ,150 5,800.6 Oregon , , , , , , ,055 1, ,715 4,556.2 Pennsylvania 2, , , , , , , , ,751 2, ,749 5,401.5 Rhode Island , ,046.8 South Carolina , , , , , , , ,900 1, ,069 3,480.2 Tennessee , , , , , , ,000 1, ,147 2, ,575 5,088.1 Utah , , , , , ,595 1, ,381 3, ,788 6,845.1 Vermont , ,460.7 Virginia , , , , , , , ,111 2, ,740 4,621.6 Washington , , , , , , ,020 1, ,765 2, ,852 5,912.0 Wisconsin , , , , , , , ,258 2, ,116 4,582.8 No data available. Case counts are suppressed if fewer than 5 cases were reported. Rate per 100,000 population. # Age in years. Rates are suppressed if fewer than 20 cases were reported. 14

23 Traumatic Brain Injury (TBI) Indicators 2a. TBI Fatalities (Overall), b. TBI Fatalities by Sex, c. TBI Fatalities by Age, d. TBI Hospitalizations (Overall), e. TBI Hospitalizations by Sex, f. TBI Hospitalizations by Age,

24 Figure 2a TBI Fatalities (Overall), 2004 Arizona Arkansas California Colorado Connecticut Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin United States Age-Adjusted Rate per 100,000 Number Rate 1, ,753 1, ,619 1, , , ,946 2, , , ,402 1,281 1,076 53, No data available. Rates are suppressed if fewer than 20 cases were reported. Rate per 100,000 population. Case counts are suppressed if fewer than 5 cases were reported. 16

25 Figure 2b TBI Fatalities by Sex, 2004 Age-Adjusted Rate per 100,000 MALES Number FEMALES Number Age-Adjusted Rate per 100, , ,620 1, , ,396 1, , ,597 Arizona Arkansas California Colorado Connecticut Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin United States , , No data available. Rates are suppressed if fewer than 20 cases were reported. Rate per 100,000 population. Case counts are suppressed if fewer than 5 cases were reported. 17

26 State Figure 2c TBI Fatalities by Age #, N Rate N Rate N Rate N Rate N Rate Arizona Arkansas California , , , Colorado Connecticut Florida , Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin United States 2, , , , , No data available. Case counts are suppressed if fewer than 5 cases were reported. Rate per 100,000 population. # Age in years. Rates are suppressed if fewer than 20 cases were reported. 18

27 Figure 2d TBI Hospitalizations (Overall), 2004 Arizona Arkansas California Colorado Connecticut Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Nebraska Nevada New Hampshire New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina Tennessee Utah Vermont Virginia Washington Wisconsin Age-Adjusted Rate per 100,000 Rate Number Percentage* External Cause 6, % 2, % 31, % 4, % 2, % 16, % 6, % 1, % 1, % 2, % 1, % 5, % 4, % 8, % 4, % % 1, % % 15, % 5, % 6, % 3, % 2, % 15, % % 2, % 4, % 2, % % 4, % 4, % 4, % * Percentage of hospital discharge data injury hospitalizations with external cause coding. Incompleteness may lead to bias. No data available. Rates are suppressed if fewer than 20 cases were reported. Rate per 100,000 population. Case counts are suppressed if fewer than 5 cases were reported. 19